PQRS: Challenges and opportunities for psychologists

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Physician Quality Reporting System

• Bonus of 0.5% on all Medicare charges for 2014
• PQRS shifts from bonuses to penalties in 2015
• Penalties: 1.5% in 2015; 2.0% in 2016 & 2017
• Applies to all Medicare charges

2015 Requirements

• Must report on 9 measures across 3 domains for
50% of your eligible Medicare Part B FFS patients
OR

• Must report on 20 patients for 1 measures group

– 11 of the 20 must be Medicare FFS patients

– Only 1 applicable measures group: dementia

Changes in 2015

• Providers with at least one face-to-face patient
encounter must include 1 cross-cutting measure

• Cross-cutting measures reflect patients’ functional
status

• Examples: tobacco use assessment, depression
screening, body mass index screening

New measures for 2015

• Anti-psychotic medications for individuals with
schizophrenia (#383)

• Follow-up after hospitalization for mental illness
(#391) - applies to children age 6 & older as well
as adults

• Both can be reported through a registry or EHR
but not claims-based reporting.

Measures eliminated in 2015

• Major depressive disorder: diagnostic evaluation
(#106)

• Substance use disorders – counseling (#247)

• Substance use disorders – screening for
depression (#248)

Changes in reporting options

Registry reporting only:

• Antidepressant medication during acute phase for
patients w/ MDD (#9)

• Preventive care & screening: Unhealthy alcohol
use—screening (#173)

Electronic health records reporting only:

• Adult MDD suicide risk assessment (#107)

Individual measures

• Preventive care and screening: Body mass index
screening and follow-up (#128)

• Documentation and verification of current
medications in the medical record (#130)

• Pain assessment prior to initiation of patient therapy
and follow-up (#131)

• Screening for clinical depression and follow-up plan
(#134)

Individual measures

• Elder maltreatment screen and follow-up plan
(#181)

• Preventive care and screening: Tobacco use
assessment and tobacco cessation intervention
(#226)

• Adult major depressive disorder (MDD):
Coordination of care of patients with specific
comorbid conditions (#325)

Quality domains

• Patient Safety:
– #130 – Documentation of medication
– #181 – Elder maltreatment

• Effective Clinical Care:
– #107 Adult MDD – suicide risk assessment
(EHRs only)
– #325 Adult MDD – coordination of care of
patients with comorbid conditions (registry
reporting only)

Quality domains

• Community / Population Health:

– #126 – Preventive screening BMI
– #131 – Pain assessment and follow-up
– #134 – Preventive Care: Depression screening
– #173 – Preventive Care: Unhealthy alcohol use

PQRS reporting options

• Claims-based – cannot be changed after claim is
submitted

• Registry – Data submitted to a qualified vendor
– Higher success rate and customer support
– Requires an annual fee

• Electronic Health Records – requires certified
technology

The need for a registry

• CMS is phasing out claims-based reporting.

• All measures groups and some individual
measures are ineligible for claims-based reporting.

• Example: psychologists can no longer report the
measure group on dementia through claims.

Advantages of registries

• Quality data submitted separately from claims

• Data can be entered into the registry after the
reporting year ends

• Eligible Professionals (EPs) can view data and add
clinical information anytime prior to submission

• EPs do not have to figure out which measures to
report or which quality codes to use

Advantages of registries

• Registry matches data with specific measures,
calculates performance, and selects quality codes.

• Registry updates all measure changes annually.

• Registries provide EPs with feedback reports.

• Success rates: 95+% for registries vs. 55% for
claims-based reporting

The APAPO registry

• APAPO is offering a mental and behavioral health-
focused PQRS registry

• Registry is being operated by Healthmonix, a
qualified vendor since 2009

• The fee for each reporting period is $199/provider
– Example: 2014 is one reporting period

• Discounts for groups of 5-29 ($179) and 30+ ($159)

Healthmonix

• Builds the website, collects and reports data to CMS
• Offers online tutorials and provider support
• Reviews claims to determine which measures apply

The APAPO Registry

• Accepting 2014 data up to mid-Feb 2015
• Last chance to earn a 0.5% bonus for 2014

and avoid a 2.0% penalty in 2016
• Report in 2015 to avoid 2.0% penalty in 2017

Questions?

Contact Government Relations at 202-336-5889
Email: [email protected]
View PQRS articles at
www.apapracticecentral.org